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N C C A M Research Blog

Research for Our Returning Veterans

July 24, 2012
Kristen Huntley, Ph.D.
Kristen Huntley, Ph.D.

We frequently hear news about the returning military troops and the health issues that they face following service in Iraq and Afghanistan. A large number of veterans experience pain on a regular basis and post-traumatic stress, traumatic brain injury, depression, and substance use tend to co-occur. Many nonmilitary people in the United States also struggle with these issues and there is an urgent need for research to identify strategies that are helpful, as well as identify strategies that may be in use that do not help with these problems.

The Office of The Army Surgeon General’s Pain Management Task Force released their Final Report in May 2010: “Providing a Standardized DoD and VHA Vision and Approach to Pain Management to Optimize the Care for Warriors and their Families[3.66MB PDF]. The U.S. Department of Defense and Department of Veterans Affairs have launched a Comprehensive Pain Management Campaign Plan. One of the objectives specified in the final report and the campaign is to incorporate complementary and integrative therapeutic modalities into patient-centered plans of care.

In a separate effort, the 2011 Institute of Medicine Consensus Report—Relieving Pain in America encourages acceleration of collecting data on pain incidence, prevalence, and treatments. This report notes that, ideally, most patients with severe persistent pain would obtain pain care from an interdisciplinary team using an integrated approach that would target multiple dimensions of the chronic pain experience.

Research on pain management is identified as a high priority in NCCAM’s Third Strategic Plan (2011–2015). With the implementation of the Comprehensive Pain Management Campaign Plan, researchers have an opportunity to study utilization and outcomes associated with the use of complementary approaches in real world settings.

NCCAM is very interested in encouraging research in military and veteran populations. Potential areas of focus could include:

  • Mining of large data sets from electronic health records
  • Efficacy, effectiveness, or the implementation of complementary approaches to pain management
  • Identification of mechanisms by which approaches could have effects.

On June 1, NCCAM’s National Advisory Council approved a concept for the development of initiatives to encourage research on the use of complementary approaches for the management of pain and associated problems (e.g., post-traumatic stress disorder, traumatic brain injury, depression, anxiety, sleep disturbances, substance abuse) among U.S. military personnel, veterans, and their families. While possibilities for conducting pragmatic research and using information from electronic health records are interesting and the publications that could potentially result from such research would be exciting, at the end of the day it is really all about reducing pain and suffering and enhancing resilience. 

What are your thoughts?

* Note: PDF files require a viewer such as the free Adobe Reader.

Comments

Comments are now closed for this post.

Did we lose the balance of strong pain medication use in strength and duration?

Did giving pain 5th vital sign status equated to use of strong pain medications, ascending on the pain medication ladder quickly and never got down? Subsequently is the pain better or added other problems?

Did incomplete management of the cause of pain due to masking pain with medications led to chronic pain and chronic opiate use? And so did the opiates prevented ability of the body to heal?

Did transfer of care in an assembly line like manner, acute care services, step-down, primary care, long term care services etc., prevented better management?

Was Pain clinic comfortable in use of higher doses of opiates? When certain local procedures used to treat pain was there effort to taper doses of opiates?

CAM modalities can be used, more so Mind Body Medicine.
Those who threw away opiates wrote How to books.

Was pain such a menace in WWI, WWII then finding the reason would help us understand the issue?

The Pain Management Task Report is an extensive well done project and would help researchers find an answer. In the meantime mindful medication use with patients’ educated involvement is the key!

It is very important to establish the Patient‐Reported Outcomes Measurement Information System (PROMIS) for the quantitative measurement of patient‐ reported outcomes (PROs) for an array of diseases and conditions, including pain, etc.
We should also establish questionnaires or scales for the symptoms upon the validity and reliability to objective evaluation and measure response to the intervention because of the complexity of symptom to patients. For example, pain could be sub-divided as distending pain, stabbing pain, colicky pain, dull pain, cold pain, burning pain, heavy pain, aching pain, and so on. Generally, pain could be differentiation between excessive pain and deficient pain, from traditional Chinese medicine. Only symptoms description detailed and pattern differentiated, can we choose right intervention and better understanding of biological effects and identify mechanisms of action of CAM.

As both a practitioner and patient I have been involved in both chronic and acute pain management. Let us agree to the reasonable stipulation that pain is an extremely subjective phenomenon, and only tangentially falls into the scientific realm of objectivity.

During the US Civil War, amputations were done within 300 to 800 meters of the field of battle. Pain mitigation, beyond whiskey, if the patient could swallow, was the only method of pain control.

Today, when I or a member of my family is questioned by a nurse or doctor about severity of pain, “with one being the least amount of pain [does pain come in amounts?] and ten being the worst, I think of the Civil War battlefields. Let’s say the worst pain I can recall experiencing in my life was a paper cut, would I call that a ten?

Where does that leave us, and, more importantly the patient. It often leaves the patient in much more pain the should be tolerated, and the practitioner in limbo.

My solution is to toss out the useless and failed current initial screening system that is a cartoon. Next the physician and patient must have an honest discussion, not on the subjective relativity of pain, but how the pain is impeding the patient’s quality of life.

Then we can begin to have a useful and honest discussion of pain management. Once that first hurdle is crossed, the more nuanced aspects of pain management can begin, without the patient feeling like he’s a stigmatized drug addict and the physician feeling anxious about “pushing” pain meds.